§ 58-17-82 — Renewal of individual health benefit plans--Exceptions.

South Dakota § 58-17-82

• Jurisdiction: South Dakota
• Title 58: INSURANCE
• Ch. 58-13: HEALTH INSURANCE POLICIES

Text

An individual health benefit plan subject to §§ 58-17-66 to 58-17-87 , inclusive, is renewable with respect to any person or dependent at the option of the person and may not be terminated by the insurer at any time, except as provided in § 58-17-15 or in any of the following cases: (1) The individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the insurer has not received timely premium payments; (2) Fraud or intentional misrepresentation of material fact by the person; (3) In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there are no longer any enrollees in connection with the plan who live, reside, or work in the service area of the issuer or in the area for which the issuer is authorized to do business and the issuer would deny enrollment with respect to the plan as provided for in § 58-18B-37 ; (4) Election by the carrier not to renew all of its individual health benefit plans delivered or issued for delivery to persons in the state. In such a case, the carrier shall provide advance notice of its decision under this subdivision to the director in each state in which it is licensed and provide notice of the decision not to renew coverage to all affected individuals and to the director in each state in which an affected insured individual is known to reside at least one hundred eighty days before the nonrenewal of any individual health benefit plans by the carrier. Notice to the director under this subdivision shall be provided at least three working days before the notice to the affected individuals. In such instances, the director shall assist the affected persons in finding replacement coverage; (5) In the case of health insurance coverage that is made available only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases but only if the coverage is terminated uniformly without regard to any health status - related factor relating to any covered individual; or (6) The insured individual becomes eligible for medicare coverage under Title XVIII of the Social Security Act, unless federal law requires that medicare coverage under Title XVIII be excluded as a reason for renewability of coverage; (7) If the issuer decides to discontinue offering a particular type of individual health insurance offered in the individual market, coverage of such type may be discontinued if: (a) The issuer provides notice to each insured provided coverage of this type in such market (and any participant and beneficiary covered under such coverage) of the discontinuation at least ninety days prior to the date of the discontinuation of the coverage; (b) The issuer offers to each insured provided coverage of this type in such market, the option to purchase all other health insurance coverage currently being offered by the issuer to an individual health plan in such market; or (c) In exercising the option to discontinue coverage of this type and in offering the option of coverage under subsection (b), the issuer acts uniformly without regard to the claims experience of those insured or any health status - related factor relating to any participant or beneficiary covered or any new participant or beneficiary who may become eligible for such coverage.

Legislative History

SL 1996, ch 286, § 17; SL 1997, ch 289, § 3; SL 2003, ch 248, § 1.